【Abstract】 Objective To evaluate the clinical application of preoperative realtime threedimensional ultrasound (RT 3DUS) in performing transjugular intrahepatic portosystemic shunt. Methods 30 patients with cirrhosis complicated by upper gastrointestinal bleeding or massive ascites due to portal hypertension were enrolled in this study. The patients were arranged to receive TIPS. Before the treatment, RT 3DUS was performed in all patients. By using color Doppler flow image to display the hepatic veins and portal vein and demonstrate the location and width of the portal and hepatic veins.Results RT 3DUS could clearly display morphologic changes of liver, the spatial relationship of the portal and hepatic veins. The distant from the puncture point of 2cm away from the opening of right hepatic vein to the right branch of the portal vein was (3.8±1.3)cm, the angle was (39.1±8.3)°. Twentysix cases were successful punctured only one time, and 4 cases two times. Conclusion As a noninvasive and reliable method, RT 3DUS can provide important anatomical information about the portal venous and hepatic venous system and basis for formulating individual schemes before TIPS，and decrease the complications about puncture.